Balki Souley lost her son during childbirth the other day. Her body was so frail, so weakened by a lack of food that she, too, nearly died. “When I return to my village, I will try to have another child,” she said shyly as she lay on the floor of a crowded maternity ward.

Married at 12, Balki is now 14 years old.

Niger has the world’s highest rate of child marriage, with roughly one out of two girls marrying before age 15, some as young as 7. As a hunger crisis affects millions here and across the Sahel region of West Africa, aid workers are concerned that struggling parents might marry off their daughters even earlier for the dowries they fetch, including animals and cash, to help the families survive.

“The fear is, if the food crisis continues, that more parents will use marriage as a survival strategy and that we’ll see more girls married before the age of 15,” said Djanabou Mahonde, the head of child protection at UNICEF.

In a landlocked nation that has one of the world’s fastest-growing populations, the hunger crisis is the latest twist in Niger’s efforts to combat early marriages, a battle pitting modern values against centuries-old traditions. Niger’s government has enacted legislation outlawing unions before age 15; in some cases, parents have been arrested and imprisoned. Government social workers and international aid agencies have initiated efforts in remote villages to encourage girls to remain in school.

Ouma Sayadou, left, 15, with her best friend in Maradi, Niger on June 16, 2012. Her aunt rescued her from an early marriage two years ago and took her from her village and brought her to Maradi, a town in southern Niger. But her parents and 20-year-old fiancee have been pressuring her to get married. Next week, she's headed back to her village to be married off. (Sudarsan Raghavan/The Washington Post)

Yet early marriages remain widely accepted by families across large swaths of the country, fueled largely by high rates of poverty and illiteracy, ancient tribal codes and conservative religious views that wield more influence than government decrees in rural communities. The average woman here has more than seven children, the highest fertility rate in the world. Half the population, which is expected to grow from more than 17 million today to about 59 million in 2050, is younger than 15. As in many parts of the continent, Niger — which has shrinking arable land, scarce rainfall and low levels of education — will be in perpetual crisis if rapid population growth is not slowed down, many experts predict.

At the regional hospital in Maradi where Balki was recuperating, the director said the number of underweight babies and undernourished mothers is rising. Usually, 5 percent of newborn babies weigh less than 5 pounds. This year, 8 percent do.

“This is related to the food crisis,” said Achirou Oumarou, the director. “People are eating leaves to survive.”

Many babies live only a few weeks, he said, adding that the hospital lacks incubators and other equipment.

Child marriage is a global phenomenon, but it is more prevalent in Africa and southern Asia. In many poor communities, girls are viewed as commodities, used as currency or to settle debts. To protect them in dire economic times, girls are sometimes married into more affluent families. Notions of morality and family honor also drive early marriages — girls are often married off to ensure their virginity. In some cases, men “reserve” especially young girls to marry them later as a way to unite families and communities.

Such marriages often bring severe health consequences. Niger, for example, has high rates of obstetric fistula, a medical condition often seen in girls that usually develops when an unborn baby gets stuck in the pelvis, cutting off blood circulation and leading to rotting of tissue. If not treated, a woman could leak urine and feces, causing other infections as well as social and psychological trauma.

Tough place for mothers

When Balki was admitted to the hospital, she was suffering from iron-deficiency anemia, a major cause of maternal death, which increases the risk of bleeding and infection during childbirth. She had not eaten properly in six months. Her tiny, fragile body struggled to transfer what little iron she had to her fetus.

In the United States, a doctor would probably prescribe an inexpensive iron supplement and a diet that included meat and vegetables.

In Niger, Balki had no such options. As per tradition, she spent the last few months of her pregnancy with her parents. With each day, her portions of millet, her only choice of food, became smaller and smaller.

Her father was forced to become a manual laborer. But the most he could scrape together was $1 or $1.50 a day, hardly enough to feed the 15-member family.

“Sometimes we had food, sometimes we didn’t eat,” said Mohammed Souley, Balki’s father. “Whenever we had leftovers, we gave them to Balki. If her hunger wasn’t satisfied, there’s nothing we could do.”

Save the Children recently declared Niger the worst place in the world to be a mother, replacing war-torn Afghanistan. In its report, the nongovernmental agency found that the average girl in Niger receives only four years of education and lives to only 56 years. One child in seven dies before his or her fifth birthday, which means that “every mother in Niger is likely to suffer the loss of a child,” the report found.

It is no coincidence, the group said, that seven of the 10 countries at the bottom of its annual list are grappling with a food crisis. Young mothers are trapped in a “vicious cycle” in which they give birth to “underweight babies who have not been adequately nourished in the womb.”

On the day she was to deliver, Balki bled profusely and nearly died. Had her baby survived, he probably would have been severely underweight, his mental and physical growth stunted by malnutrition.

In a culture that values having many children, to help around the house and in the fields, Balki faces immense pressure to have a child. In the ward, relatives said she had dropped out of school two years ago. “If the girl is not going to school, what is she going to do?” said Amina Ado, her grandmother. “She has to get married and give birth.”

A few moments later, her aunt, Saa Rabiou, said, “Some of Balki’s friends, who are her same age, already have two babies.”

‘Hard to stop’

Judge Omar Boubaker, who handles child abuse cases in Maradi, recounted a rare child marriage case handled by a colleague that underscores the challenges the government faces in eliminating the practice.

A 13-year-old girl’s uncle promised her in marriage to someone to whom he owed money, as a way to settle his debt, but without her father’s knowledge. When the father learned of the impending union, he swiftly married her off to another man. The uncle, who according to local tradition also serves as the girl’s guardian, took the father to court.

The judge sided with the father and allowed the first marriage, Boubaker said. Legally, he should have annulled the wedding because the girl was younger than 15, the judge said. But “traditions and religion are very strong,” he said, adding that they were stronger than a commitment to the law.

In the village of Madaroufa, Zahara Sani, 12, doesn’t want to go back to school. She wants to marry her 20-year-old fiance. As a bride price, the young man gave her father shoes, bracelets, earrings, perfume — and $260, a princely sum here.

But a soldier in their village reported her father to authorities. A judge banned the wedding, and government social workers have warned the father that they will have him arrested if he allows his daughter to marry.

The marriage has not been called off, and neither has the dowry been returned. And Zahara is determined. “I have four friends who are already married, and we are all the same age,” she said. “Why not me?”

“These marriages are hard to stop,” said Saidu Omarou, a child protection officer who helped prevent the union. “Parents are now marrying their girls off secretly.”

Ouma Sayadou, 15, fled her village two years ago after her parents betrothed her to a much older man. She now lives in Maradi with her aunt, a nurse who also escaped an early marriage. Ouma’s aunt became her guardian and enrolled her in school, hoping the girl would go to college.

But her parents and fiance have been calling incessantly, sometimes three times a day, urging her to leave her aunt’s house and return home, to give up her education.

They may soon get their wish. Ouma’s aunt, who is 30, is getting married and can no longer take care of her. So next week, Ouma is returning to her village. In an interview, she broke down crying, unable to speak.

“They are going to marry her off, and she can’t refuse,” said Delphine Mensab, an aid worker helping Ouma. “She’ll never go back to school.”